Apr 8

ICD-10-CM vs CPT vs HCPCS Explained

ICD-10-CM: Diagnosis Coding

  • ICD-10-CM stands for International Classification of Diseases, Tenth Revision, Clinical Modification.

This coding system is used to describe:

  • Diseases
  • Injuries
  • Symptoms
  • Conditions
  • Reasons for healthcare encounters

Examples include:

  • Diabetes
  • Hypertension
  • Pneumonia
  • Fractures

ICD-10-CM codes explain why a patient received medical care.

Important ICD-10 Concepts

Students must learn:

  • Laterality
  • Combination codes
  • Excludes notes
  • Sequencing guidelines
  • Placeholder X
  • Acute vs chronic conditions

CPT: Procedure Coding

CPT stands for Current Procedural Terminology.

CPT codes describe:

  • Physician services
  • Surgical procedures
  • Office visits
  • Diagnostic testing
  • Radiology services

Examples include:

  • Office visits
  • Surgical procedures
  • Injections
  • Imaging studies

CPT tells the payer what service was performed.

CPT Categories

Category I - Standard procedures and services.

Category II -Performance measurement codes.

Category III -Emerging technology and experimental procedures.

HCPCS Level II: Supplies and Non-Physician Services

HCPCS Level II codes are commonly used for:

  • Ambulance services
  • Durable medical equipment
  • Prosthetics
  • Medications
  • Medical supplies

Examples include:

  • Wheelchairs
  • Crutches
  • Oxygen supplies
  • Injectable medications